Hypoglycaemia following Partial Gastrectomy

During a routine follow-up of 45 consecutive patients on whom a partial gastrectomy had been performed for peptic ulcer we noted symptoms of dizziness, palpitation, sweat ing, epigastric discomfort, and a feeling of weakness progressing in several instances to complete loss of con sciousness-in 17. These symptoms, coming on in from one-half to one and a half hours after food, were rapidly relieved by taking sugar or other easily assimilated carbo hydrate. In this series they were far the commonest com plication of partial gastrectomy, being greatly in excess of stomal ulcer and anaemia, which receive such a prominent place in the literature on the subject. Five of the patients were in consequence so severely disabled that they had become totally unfit for employment. Many of them, however, did not associate their symptoms with their oper ation, as their sensations seemed to be quite unconnected with the previous dyspepsia. In a follow-up of patients who have had a partial gastrectomy this syndrome may therefore be overlooked unless leading questions are asked. Such symptoms have been noted previously, chiefly in the German literature by Lapp and Dibold (1933), Beckermann (1933), Koranyi (1936), and Wohrle (1936). Evensen (1942) found that in 34 out of 95 cases of partial gastrectomy the blood sugar fell on occasion to less than 65 mg. per 100 ml. Adlersberg and Hammerschlag (1947), investigating the post-gastrectomy syndrome, demon strated a hypoglycaemic type of blood-sugar curve in all their 14 cases. There is a curious absence of reference in British literature to post-gastrectomy hypoglycaemia; the dumping syndrome, however, is often mentioned, but is usually attributed to vagotonia, the result of jejunal dis tension from precipitate gastric evacuation.